Part Timer Blues

Dear Director,
I’ve been a dedicated part-timer for years, but now I’m not getting my shifts. Why is that, and what can I do about it?
Signed,
Left Out

Dear Dr. Outfield,
In the interest of full disclosure, I am both a scheduler with part-timers and I work part-time in another facility, so I’ve seen both sides of the problem you describe. In my own part- time work, I’ve submitted schedule requests when they’ve been so overstaffed I didn’t get any hours for months at a time. At other times, I’ve been asked to work more than I typically would because they’ve been so understaffed and desperate for attending coverage. Through it all, I’ve maintained credentials, completed the in-house mandatory CME and considered leaving numerous times (particularly when I’m driving to my second hospital for a 6 p.m. risk management lecture that’s a credentialing requirement).

Love or Hate?
On the positive side, dedicated part timers like yourself provide a valuable service to medical directors (or whomever does the schedule). They work weekends and holidays and in general make life a little better for the full-timers when the ED is temporarily understaffed. Obviously, when the ED is fully staffed, the scheduler will make sure all of their full-timers get their hours and their own requests. While this may be the simple answer to your problem, there are other ways in which a part timer can become problematic for an ED director, causing a reduction in hours.

First, there’s the problem of efficiency. Simply put, part timers will rarely be as efficient, or be able to troubleshoot a problem as easily at their part-time gig as at their regular job or as their full-time colleagues. Years ago, there was a part-timer working nights in my ED. The group loved the idea until we realized that when we got sign out from him at 7 a.m., it usually meant having to see a half dozen patients that were in rooms for hours and hadn’t been seen. Funny enough, when we got sign out from our regulars, that never happened. Initially, we thought it was just the misfortune of some really busy nights, but ultimately, we saw the numbers and realized he just couldn’t keep up with the typical volume. He didn’t last long, as the pain of the extra night shifts was outweighed by the pleasure of showing up for a day shift and a cleared rack.

Another issue is that part-timers are less likely to fully buy in to the culture and vision of that particular ED. It may not be intentional; it might just be that they’re not at the staff meetings, consistently reading the memos or have an understanding of the local hospital politics. In many ways, part-timers make many of the same mistakes that new doctors make: not following a typical referral pattern, using heparin instead of enoxaparin (or vice-versa) or just not quite following the ED’s regular practice pattern. None of these are whopping mistakes, but they all typically lead to the, “I just wanted to let you know about one of your docs,” complaints from medical staff members who catch me in the hallway or at a meeting. The take-away lesson is that if you’re not aware of what your clinical score card looks like, now’s the time to find out. Meet with your medical director and compare your RVUs/hour, patients/hour, RVUs/patient, core measure accomplishments, etc… with the rest of the group. If you note a deficiency, make a written plan to improve, get monthly feedback and try to at least be average.

Some drawbacks to scheduling part-timers are built into the arrangement and are more-or-less beyond the physician’s control. By definition, part time physicians rarely clock enough clinical hours to truly become a part of the establishment and gain the trust of the nurses and the admitting physicians. Also, there is the issue of priorities. When push comes to shove, part timers are likely to put a higher value on their full-time obligations, possibly leaving the ED in the lurch at the last minute. It’s important to be cognizant of this and when you’re supposed to be working your part time job, make sure you’re 100% mentally and physically present.

Your Contract
Contracts are in place to answer questions about clinical commitments among other things. Since malpractice insurance may be paid per physician, it’s not unusual to have a contract guaranteeing/mandating that you work a certain number of hours. If you’ve always worked the job with a half-time commitment, you may have even put into your contract that you wanted 80 hours per month. If that’s the case and you’re not getting your hours, you may be entitled to some income or at least be able to get the shifts that you want. On the other hand, some contracts are written as “PRN,” meaning that you are guaranteed zero hours per month, but you also don’t owe any hours if you don’t want to give them. If that’s the case, your employer can cut you back, and there is really nothing you can do about it from a contractual point of view. Go back and take a look at your contract to be sure you and your employer are following it.

In summary, EDs almost universally need part-time physician coverage, but recognizing that the hours available may change from time to time is important. Part-timers often fly under the radar, not performing up to expectations. In times of need, this will be overlooked. However, when they are fully staffed, the part-timers are the last on the list. If you want consistent hours, meet with your medical director to review your scorecard and make sure you’re a committed team member—both culturally and by the metrics. Finally, consider amending your contract, if possible, for a guaranteed clinical amount that both your and your department can benefit from.

Michael Silverman, MD, is chairman of emergency medicine at Harbor Hospital in Baltimore, MD and is on TEAMHealth’s Medical Advisory Board.